Biomedical subjects
Publications and source records attributed to Y Tekant.
An alternative technique for laparoscopic appendectomy is described. The isolated appendix is exteriorized through the trocar wound, ligated, and resected. The cecum is then returned to the abdomen.
The successful performance of laparoscopic cholecystectomy in a patient with situs inversus viscerum and empyema of the gallbladder is reported. The 62-year-old man presented with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and a palpable globular mass in the same region. CT scan demonstrated a distended gallbladder with thick shaggy walls which contained a 2 cm gallstone in the neck and also revealed dextrocardia and situs inversus. The patient's postoperative recovery was uneventful.
This report describes the technique of totally intra-abdominal Billroth II gastrectomy. Because the procedure is minimally invasive, patient recovery is remarkable compared with the conventional open technique. The development of this procedure completes the minimally invasive revolution in the management of peptic ulcer disease, which began with the introduction of laparoscopic vagotomy.
Endoscopic haemostasis is becoming increasingly important in the management of bleeding peptic ulcers. In this study, rather than being confined to one modality of treatment, the endoscopist was allowed to customize the treatment according to the configuration of the ulcer, accessibility, and rate of bleeding in any particular patient. Fifty patients with actively bleeding peptic ulcers or stigmata of recent haemorrhage were treated endoscopically. Initial haemostasis was achieved in 48 (96%) patients. Eleven patients rebled of whom eight underwent repeat endoscopic treatment. Of these eight patients, three rebled of whom two required surgery. Permanent haemostasis was achieved in 43 of 50 patients (86%). The rate of surgery in the endoscopically treated group was 10%. There was one death due to causes not related to bleeding. The multimodality approach is a useful method of treatment in bleeding peptic ulcers, giving flexibility to the endoscopist in deciding on the best way to deal with the problem.
The role of endoscopic haemostasis in the treatment of bleeding peptic ulcers is widely studied. Many trials to date have compared one or more modalities against a medical control with variable results. To date, no single modality has been shown conclusively to be superior to others. As such, in this study we have not confined the endoscopist to one modality of treatment but allowed him to customize the method of endoscopic haemostasis according to the configuration, accessibility and rate of bleeding in any particular patient. Seventy-three patients with non-variceal upper gastrointestinal (GI) bleeding were admitted to the National University Hospital in Singapore between May 1, 1988 and April 30, 1989. All were gastroscoped and 48 were found to have chronic peptic ulcer. Twenty-nine (60%) with actively bleeding peptic ulcer or stigmata of recent haemorrhage (SRH) were treated endoscopically. Initial haemostasis was achieved in 27 (93%) patients. Seven patients rebled (26%) of which four underwent repeat endoscopic treatment. Of these four patients only one rebled again and required surgery. Permanent haemostasis was achieved in 23 of 29 patients (79%). The multimodality approach for the treatment of bleeding peptic ulcers gives the endoscopist flexibility in deciding on the best way to deal with a bleeding gastric or duodenal ulcer. Each instrument has its strengths and weaknesses and the right choice of instrument is often a critical factor especially in treating a bleeding ulcer in a situation where access poses a problem.
In a retrospective study, we reviewed 97 consecutive cases of squamous cell carcinoma collected over a five-year period (1978-1983). Resection of the tumour was possible in 30 out of 40 patients subjected to surgery. Of these 30 patients, five died within 30 days of surgery. Eight patients who underwent oesophageal resection were still alive after five years and apparently cured. Bypass surgery for unresectable lesions in six patients were complicated by anastomotic leakage in three patients. Patients unsuitable for surgical resection were treated using Celestin tube insertion or radiation. Mean survival in 13 patients with Celestin tube insertion was 4.1 months. Of 48 patients who were treated by radiotherapy, two lived beyond five years. Surgical resection restores swallowing effectively and offers a 25% chance of cure and should be done in fit patients. In unfit patients with advanced disease, palliation from the use of radiotherapy and Celestin tube insertion were poor. Newer techniques such as endoscopic laser recanalisation and bicap hyperthermia may need to be considered for palliation in this group of patients.
This case report details the use of a pulsed tunable-dye laser lithotripter in the endoscopic management of recurrent intrahepatic stones in a patient with Oriental cholangitis. A 42-year-old Chinese man had a cholecystectomy and choledochoduodenostomy in 1980. Subsequently he had three episodes of recurrent cholangitis which responded to medical treatment. The patient presented in April 1989 with a fourth attack of cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound demonstrated a large mass of stones in the right intrahepatic ductal system. A flexible upper gastrointestinal endoscope was passed into the right hepatic duct via the choledochoduodenostomy. The stones were fragmented with a tunable-dye laser and the residual fragments were removed endoscopically.
Explore the source record for details and available documents.
Explore the source record for details and available documents.